Provider Demographics
NPI:1659688471
Name:SHAW, LAUREN M (MS-OTR/L)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:SHAW
Suffix:
Gender:F
Credentials:MS-OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ELMCROFT RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7738
Mailing Address - Country:US
Mailing Address - Phone:585-820-1753
Mailing Address - Fax:
Practice Address - Street 1:41 ELMCROFT RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7738
Practice Address - Country:US
Practice Address - Phone:585-820-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015156-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015156-1OtherLICENSE NUMBER